The Short-term Efficacy Of Catheter-directed And Systemic Thrombolysis Therapy In Treating Lower-extremity Deep Venous Thrombosis And The Change And Significance Of P-selectin Before And After Treatment

Objective:Lower-extremity deep venous thrombosis (LDVT) is acommon and frequent disease of vascular surgery.Its main complications arepulmonary embolism and postthrombosis syndrome,which seriously influencepatients’ quality of life.The traditional treatments of LDVT includeanticoagulation,systemic thrombolysis and surgery.But various treatmentshave their limitations.Catheter-directed thrombolysis (CDT) as a new methodof thrombolytic therapy,which can improve the efficiency of thrombolysis,hasbeen used in treating LDVT at present.P-selectin as a vital adhesion moleculecan reflect the state of platelet activation and mediate adhesion betweenvascular endothelial cells,platelets and leukocytes.So P-selectin plays animportant part in thrombosis and inflammation.It has been proved thatP-selectin may be involved and play an important role in the venousthrombosis by more and more studies.Our study aims to evaluate the safetyand efficacy of CDT through observing and comparing the short-termefficacies of CDT and systemic thrombolytic therapy in treating LDVT.Wealso determine the change of P-selectin in the plasma of the patients boforeand after treatment to disscuss the relationship of P-selectin and LDVT.It mayprovide new methods and theoretical basises for the early diagnosis andtreatment of LDVT.Methods:44patients who had been confirmed with unilateral central ormixed type LDVT by ultrasonic or venography from the February of2011tothe December of2012were selected as LDVT group.20cases in healthycheck-up were selected as normal control group.The inclusion criteria ofLDVT group:(1) suffered with unilateral central or mixed type LDVT(2)age≤ 75years old(3)the duration of symptom≤7days and had pain or swelling inthe affected limbs(4)D-dimer in plasma＞0.5mg/L(5)no treatment beforeadmission(6)no contraindication of anticoagulation,thrombolysis andvenography(7)the functions of liver and kidney were good(8)no malignanttumor,diabetes and cerebrovascular diseases(9)no taking antiplatelet drugs innearly three months(10)agreed to participate in this study.The patients wereclassified randomly into the catheter-directed thrombolysis group(CDT group)and the systemic thrombolysis group(ST group) according to the differentmethods of treatment.CDT group had20cases and ST group had24cases.Allpatients were immobilized and the affected limbs were raised up after inhospital.All patients were treated with low molecular weight heparin foranticoagulation.The inferior vena cava filters were placed in all cases of CDTgroup through the normal femoral veins.Subsequently thrombolytic catheterswere placed into the thrombus in the same way.The urokinases werecontinuously pumped into the catheters at the speed of500000U per day.Weviewed the state of thrombolysis by venography and adjusted the position ofthrombolytic catheters in time to keep the side holes completely intothrombus.The function of coagulation was determined everyday and thebleeding complications were closely observed in the process of thrombolysis.500000U urokinases were dissolved into250ml0.9%sodium chloride injectionthen dripped into median cubital vein once a day.The indications of stoppingthrombolysis:(1)fibrinogen in plasma<1g/L(2)thrombus had been completelydissolved(3)thrombus was no obviously dissolved in recent venography(4)thepatients had serious complications.The short-term curative effect:(1)The effectof limbs swelling:In LDVT group,the circumferences in both lower limbswere measured on thigh(above patella15cm)and shank(below patellar10cm).The differences of circumferences between healthy and affected limbswere calculated before and after thrombolytic therapy.The swelling rates ofaffected limbs were calculated by the differences of circumferences before andafter thrombolytic therapy.(2)The effect of thrombolysis:The scores of venouspatency were evaluated by the intravenous ultrasonic or venography before and after thrombolytic therapy.The rates of venous patency improvement werealso calculated according to the scores of venous patency before and aftertreatment.(3)The dosage of urokinase and the time of thrombolytic therapywas recorded.The measurement of P-selectin:All patients’ blood were drawedfrom the median cubital vein and placed into anticoagulant vacuum tubesbefore and after thrombolytic therapy.The blood of normal cases were drawedin the same way.All specimens were centrifugated for15minutes at the speedof3000r/min on the room temperature.Then the above plasmas were taken upand frozen in the refrigerator on-80℃.The concentration ofsoluble P-selectinwas measured by the methed of indirect sandwich in ELISA.Results:1The effect of limbs swelling:The differences of circumferences on thethigh and shank of both lower limbs after thrombolytic therapy are lower thanthat before in CDT and ST group(P<0.05).The differences of circumferenceson the thigh and shank of both lower limbs in CDT group are significantlylower than that in ST group after thrombolytic therapy(P<0.01).The swellingelimination rates on the thigh and shank of the affected limbs in CDT groupare significantly higher than that in ST group(P<0.01).2The effect of thrombolysis:The scores of venous patency afterthrombolytic therapy are lower than that before treatment in CDT group andST group(P<0.05).The score of venous patency after thrombolytic therapy inCDT group is significantly lower than that in ST group(P<0.01). The rate ofvenous patency improvement in CDT group is higher than that in ST group(P<0.01).3The dosage of urokinase and the time of thrombolytic therapy in CDTgroup are lower than those in ST group(P<0.01).4The measurement of soluble P-selectin:The concentration of solublep-selectin in LDVT group is higher than that in normal control group beforeand after thrombolytic therapy(P<0.05).The concentration of soluble p-selectinin LDVT group after treatment is lower than that before(P<0.05).Theconcentration of soluble p-selectin in CDT group after thrombolytic therapy is lower than that in ST group.But the difference is not significant(P>0.05).Conclusions:1CDT can relief the symptoms of LDVT more rapidly than systemicthrombolysis.2CDT can improve the rate of thrombolysis and restore venous patency.3The short-term efficacy of CDT is superior than systemic thrombolysis.CDT as an effective and safe treatment for LDVT is worth popularizing in theclinical.4The soluble P-selectin in plasma is related to LDVT.It may be used toprevent and diagnose LDVT early.It also may play an important part intreatment for LDVT as a target of new antithrombotic drugs.